<p> Payroll/ Associate Change Form</p><p>CHANGE INFORMATION EFFECTIVE DATE FIRST NAME M.I. LAST NAME</p><p>CHANGE FROM TO</p><p>HOURLY RATE OR ANNUAL SALARY</p><p>INCENTIVE PAY PERCENTAGE</p><p>SALARY LEVEL</p><p>JOB TITLE</p><p>DEPARTMENT NUMBER</p><p>MANAGER (REPORTING STRUCTURE)</p><p>OTHER NEW HIRE (OR REPLACEMENT) *If replacement, for whom: </p><p>PROMOTION WAGE ADJUSTMENT</p><p>TRANSFER RETIRED/RESIGNED DISCHARGE *Select a reason below*</p><p>Absenteeism Gross Misconduct Job Elimination Layoff</p><p>Failed to return from leave Performance Quit w/out notice Other: </p><p>* Please refer to the Approval Matrix to obtain necessary signatures. REQUIRED SIGNATURES DATE MANAGER</p><p>PLANT MANAGER or DATE DC/ DIRECTOR DATE VP DIVISION DATE VP FINANCE DATE HUMAN RESOURCES DATE CEO ADDITIONAL COMMENTS</p><p>HR USE ONLY</p><p>EEO REQ.# Direct Reports Y N **Reminder: Please generate a PCN for direct report changes and send email notification.** Direct Indirect Salaried </p><p>1.800.999.04000 STANDARDTEXTILE.COM</p>